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HomeMy WebLinkAboutBuilding Permit #50-12 - 53 WHITE BIRCH LANE 7/20/2011nit 0 TOWN OF NORTH ANDOVER r l�' APPLICATION FOR PLAN EXAMINATION Permit N9• - _ ,,. Date Receivedj/ �J/ Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION __Q,4%*4 r i a' k L Print PROPERTY OWNER fir k -1 o- L• S2 2 h d C o S Unit # Print MAP NO:4�Y7 PARCEL:?o ZONING DISTRICT: Historic District y n Machine Shop Village es no 100 year-old structure es TYPE OF IMPROVEMENT PROPOSED USE Residential ❑ New Building **One family Non- Residential ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: KRepair, replacement ❑ Commercial ❑ Assessory Bldg ❑ Demolition ❑ Other ❑ Others: Li Yr clii.1/ JL4Vti.d ' Ali i DESCRIPTION OF WORK TO BE PERFORMED: to lo'X 11' oi<•c� i'f alai X i1' d A ,r+tc+� Ci�2irS �clifl, (Identification Please Type or Print Clearly) OWNER: Name:_F�-?_4. je P- L. -co Q , Address: S3 GJyi.i�c �3:�a� LAa%e,. CONTRACTOR Name: 2{o, J/d,, Phone: Address: 9 /2,'//Cvi c? � Supervisor's Construction License: j 3 Exp. Date: — 7— Home Improvement License: loS yy 3 Exp. Date: -7—/7— ARCH ITECT/ENGI NEER 7—/7_ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ /7 /yG . FEE: Check No.: Receipt No.: NOTE: Pers ns contracting with unregistered contractors do not have access to the guaranty fund ;,.ignature ofAgent/Ovvner - Signature of contractor 4% cel , — -1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. Permanent Durnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS DATE REJECTED El DATE APPROVED El V�l':`IV �: �� tJivi iGtUil: COMMENTS Q, W ' N� HEALTH Reviewed on f Si nature en Ice COMMENTS SLG .-�- Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 0 Dimension Number of Stories: Total square feet of floor area, based on `xterior dimensions. A k; 11 Total land area, sq. ft.: ELECTRICAL: Movement of Dieter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc:.Building Permit Revised 2011 June/mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg P Addition or Decks ❑ Building Permit Application � ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses �' � Coljv Of Coni:rncit- * i. iooi-/ ..f ossectioi`iiElevai ioi l Pian Gi' Proposea vvorK vvim zjpr1fiKICr i�ian , A110 Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permi VNOTE: New Construction (Single and Two Family) NOTE: ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permitl In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Location�,Z�h�" No. "u -44-f Date NOATN TOWN OF NORTH ANDOVER f?O•,t``o .•,hOR O i � • a + , . Certificate of Occupancy $ , ;,SSA�MUSEt� Building/Frame Permit Fee $,A'r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �d U 246, J Building Inspector g k A Qife"S C-MPosde ref to to n� st, n n fi I I N � n x h � b w 0 x %A i N di a T r r 7U H r m m X m X U) v m c H 'O CO) Cl) 10 0 CD a ZCD 0 y r c d � y '00 o v CD CD o CLQ d CD CD o CD I= w a. C• CD y CD CL O CO) I Cc CD S v CO) O 'O Z O O O CD O CD 9.3 CY C O 0 Z 0 m O 7 tC 0 C CO CIS0 C43 CLCA0 y m c'�` d �. y Qo y ?7 `^' 'jJ ar D M CL C.) m CA O.d 01= y o C=L .a O O ro O yCD O f CD �pn .i Cf) b 0' Cb M O s .Z2;CX Oy, C! H ;&O m =r0"t) W ay CL -� CDm � C)= CL no 0 0; m Q y d y co ? CL n, Q W- a �o Cc CD y H Q C m m CO) CD 2 CO) Cl) m T m CO2 2 z O O Cn 0 C7 Cn B 0 til MO G ?7 `^' 'jJ ar _ M r D CA b p CD ro v FCD C DCA f Fm 1 x Ca G Cf) b 'rl O C Cb M s H W O 7d � o CCE �+ no 0 0; � Q 0 C co � �o c = ' ►j Cn 0 C7 Cn B 0 til MO G ?7 `^' 'jJ ar y 171 'a c O Jr-, b p O 'k, ro ':7 p n � and O -1 O Ca G Cf) b 'rl O C Cb M H O 7d � � omi 0 Ll 16 Ironwood Street License: CS 3513 Billerica, MA 01821— -- — — HIC Reg. 105443 Tel: 978-663-3015 s — . DATE: 2 i Walter A. Sloper Construction Company A TI TI TTIf-NXTC T31C1k f-%TIL'T TkTi- . 1XTTDDT1ID CTATTCi7 ram k LI' s a 219#1j_ os 1[t35-3 Wkid 6'rc4, Lah,e pt over , QUANTITY DESCRIPTION AMOUNT TOTAL DC #"&a Re- c e -xi i do #--vls isd a-ir F�r2,»ti 11'x a 0 d cck w4A 4 c ou.si— s f; H ♦ sf3 Z -v- SI -I n trt 2X l a- F t, d 24Cr,,-Ce c o ��sf�Hccl w 4 c-1,',QS Zsd deOr se-.-eaS. Rims ao%olsr ht2 C« et! 6- G k z2 i r C rs oK i Az is- s itj;ij,vy arc az.0 e t bti edeas -17A 5 -12 t < Ift o s it c jo os7` s lcGv C2 6 es e. 7Lo4i-i a -e ial am r aq 13 z nal hiitees 2 et n r cz ot, o� ^ 5h,'-ks – t �a�arr / ,4 -� �- o- f h w ,4k 94ovo Pfz 4 «s er aD 16 A TI TI TTIf-NXTC T31C1k f-%TIL'T TkTi- . 1XTTDDT1ID CTATTCi7 3 a 'off !*, -e s i; ,1 n N�� ' O J f � t� X Coop o s we 7rez{ 9' X � .1 r �I j; c C� P 0 p •�n L 3 s x r d k � N � n 't � � f vp b C, a 'off !*, �~ yy Cn i; s x r d k � N � n 't � � f vp b C, a 'off !*, �~ yy Cn ,1 n N�� ' O J f � RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home improvement contractors and subcontractors engaged in home improvement contract- ing, unless specifically exempt from registration by provisions of Chapter 142a of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and statusshould be made to the Director, Home Improvement Contract Registration, O-ne Ashburton Place, Room 1301, Boston, MA 02108. Designated Registrant's Name: W 2//" 'u er, Registration Number: /0_57 Y/ 9 3 Salesperson's Name: This agreement is made on between (�/�,w .f /eA t ✓ (DATE) (ONTRACTOR) Of X ' ryinmi e.sof Sf. .�...�a2 A�il-3�%Sr -CGY-OO Y i (ADDRESS) (PHONE NUMBER) hereinafter called "Contractor" and lc"a„ k *Arm !32 nz co S (OWNER) of __J-1 G-Jk,`,rc %jirc /t.+t A) Afa✓ksot✓ &IP. �7� 979'�lOrG_O (ADDRESS) (PHONE NUMBER) hereinafter called "Owner". I. DETAILED DESCRIPTION OF WORK TO BE PERFORMED Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work consists of the following: 2C4 PV<_ ii vs ej,-Clt /0X13.c7't2// AJ cod at> )e /J dc6/( w,V4 DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials to be used in performing the above described work consist of the following: R '1`.kl�. - ale !e - Jk - �k� Y)(y " drcktr►t r bar 4Cae.% iz e k 1V.c �e�cf-F�,Fr�sr q0011 PsT J'f`ec/ .c' G.j '2 ro/ II. PRICE Contractor agrees to do all work described in Section I for the total price of $ 17114 . III. PAYMENT Payment will be made as follows: y5- 1-33—H31 % ($ _141,% s° ) upon signing Contract; —� % upon completion of,�,t. :- S % ($ ����' s ) upon completion oFrs.,,cM and the remaining$ ` 1$ C - S* �'� % ( )upon verification of the work by Owner and Contractor as having been satisfactorily com- pleted, which verification shall take place promptly after completion. Notice: No agreement for home improvement contracting work shall require a down payment (advance deposit) of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount is greater. IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified here in writing. Contractor will begin the work on or about 7-1$— 11 (date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by '1' 30 - L1 (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. V. NO ACCELERATION OF PAYMENTS BUT ESCROWING ALLOWED The Contractor may not require payments to be made in advance of the times specified in Section III (Payment) above for the reason that he deems himself or the payments to be insecure. If, however, he deems himself to be insecure, he may require, as a prerequisite to continuing the work described herein, that the balance of the payments under this contract that are in the control of the Owner, shall be placed in a joint escrow account that requires the signature of both the Contractor and the Owner for withdrawal. VI. INSURANCE Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by himself, his employees or his subcontractors in the performance of, or as a result of, the work under this Agreement. Contractor agrees to carry insurance to cover such damage or injury. VII. SUBCONTRACTING Contractor agrees that, notwithstanding any agreement for materials and/or labor between Contractor and a third party, Contractor is responsible to Owner for completion of all work described in a timely and workmanlike manner. VIII. CONSTRUCTION -RELATED PERMITS The following construction -related permits will be necessary in order to complete the scope of work included in this Agreement: sm n cf C t - The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction -related permits. The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory, permit granting or inspectional agencies, authorities or individuals. Notice: If the homeowner obtains his own construction -related permits for the work described under this agreement, the homeowner is hereby advised that in the event of a dispute, judgment and nonpayment of the contractor, the homeowner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A, M.G.L. IX. MODIFICATION This Agreement, including the provisions relating to price (Section II) and payment schedule (Section III) cannot be changed except by a written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice of Cancellation (annexed). X. WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of Iye2y following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired, or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. All warranties for equipment supplied by the Contractor under this Agreement shall be those given by the manufacturers of such equipment, which shall be and are hereby passed through directly to the Owner. Under such manufacturers' warranties, the Owner maybe required to register or mail in a warranty card or other evidence of ownership and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such documentation, which failure voids the manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such equipment. This warranty gives the owner specific legal rights, and owner may also have other rights which vary from state to state. Under Massachusetts law, sales of goods carry an implied warranty of merchantability and fitness for a particular purpose. XI. COMPLETENESS OF AGREEMENT FOR EXECUTION The Owner is hereby advised that he should not sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable,n� until all exhibits and related or referenced documents that are incorporated herein are attached hereto. XII. COPY OF AGREEMENT TO BE GIVEN TO OWNER This Agreement is governed by the Laws of Massachusetts. It must be executed in duplicate, and an original signed copy hereof given to, the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the owner of a copy thereof. RIGHTS TO CANCEL The owner may cancel this agreement if it has been signed by the owner at a place other than an address of the contractor which may be his main office or branch thereof, provided that the owner notifies the contractor in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See attached Notice of Cancellation. HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 7 g ll Owner's Signature Date Signed 4 IJ hf lel Contractor's Signat re Date Signed H - GG 25M 6/92 Restricted to: 00 00 - Unrestricted IG - 1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. - Refer to: WWW. Mass. Gov/DPS License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid wit out signature 9 0 Nlass acfits Nots - Department of Public Board of Builtiin-, Reumlations ;tial �tantlat zls Construction Supervisor License E License: CS 3513 Restricted to: 00 WALTEWA SLOPER 16 IRONWOOD ST BILLERICA, MA 01821 4 �-�_ i Expiration: 6/7/2012 Commissioner Tr#: 26683 Office f Cov�u"m rnATairasfBdsiness egulah� HOME IMPROVEMENT CONTRACTOR Registration: 105443 Type: - Expiration: 7/1-7/2012 DBA - r ER A. SLOPED CON4TRUCTION Walter Sloper ` 16 Ironwood St Billerica, MA 01821' Undersecretary The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street r Boston, MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bl Naive (Business/Organization/Individual):_ S 1c) p G f' C✓" S 7�• Address: I( _ 1, 0, r,.1 "cJ S+. City/State/Zip: i ; 11 r v-; ca Phone k Ci � ;f - 46q- a d y 7_ Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I mployees (full and/or part-time).' have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11.0 Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box fil must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. Iam an employer that is providing workers' compensation insurancefor my employees. Below is the policy andjob site information. Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip:. Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. sign 0: Date: Phone #• Q 7 r ,(O q— 6 D Y7 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Persoin: Phone #: APPLICANT ":� 3 Phone LOCATION. Assessor's Map Number Parcel Subdivision w ) Lot (S) Street CJ(I�� /2 St. Number) ************************Ofrcial Use Only*********************** RECO NDATIONS OF TOWN AGENTS: r 1 Conservation Administrator t ti Comments 4 Town Planner Comments Food -Inspector -Health Septic Inspector -Health Comments Date Approved Date Rejected Date Approved y q� Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewerfwater connections P; � E driveway permit Fire DfaFVy men ! � , . _ f�-� /Received Building Inspec'ZIto Date APR - 6 1994 ulwliy . gE: 'f4+5 PL"j Ih JDT EYE �tNl.). i�ff A 5-4434UCAs' 124r L 6. 28,7 09'Mri , VT 15- A c ecow pr- fa s L.aurb�l Its b 35. ANO ELEVMlai ?F Tab f>*Tluci >Y9t@rt "r' ► • 1 0.l} SA _L :• cofrPoNEa ry. 39 tx( tt 57QI7 pr etc. d I� II r*L r7 N I J 0 4•`tJJ wF.o, I � 0 u i6ai rm.tl, 0u�'iQ �C�,r �ilfw� t . t q� t.c� ✓ 3 0 2006 S $ o Ln.,Gia F;v p pk r {EO'v tJN ITE 8 Inr�C1 Ln.r-�� AS E !'1LT PLAN SUBSURFACE DISPOSAL SYSTEM -- LOCATED IN !SnrG•i'k{ AEsc?©VER., HAhy; / 5�S 1J441T5 51eg:i4 LArsE AS PREFARED FOR Ila A s9 {' E•A 1••►v— e' L1`-�!A IJ4NAG0 �? O� VLADNIAL CSG' c �}{ENOK m SCALE: 4o. fir_ o ASO 9FG/STEN`�t FESS/ONAI�G� MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET 0 ANDOVER, MASSACMUSETTS 01010 d TEL 1617) 473.3555, 373-Sni